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  • Küçük Resim
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    Brief review of right aortic arch with aberrant left subclavian artery
    (Thieme Medical Publishers, Inc., 2019) Öztaş, Didem Melis; Umutlu, Muzaffer; Ertan, Melike; Beyaz, Metin Onur; Badem, Serdar; Erdinç, İbrahim; Ulukan, Mustafa Özer; Ünal, Orçun; Conkbayır, Cenk; Alpagut, Ufuk; Uğurlucan, Murat
    Development anomalies of the aortic arch and its major branches are rare congenitalcardiovascular disorders. In this article, we present aberrant left subclavian arteryassociated with right aortic arch.
  • Küçük Resim
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    Follow-up results of aortic arch cervical debranching performed with the help of a temporary crossover external carotid artery bypass for cerebral protection followed by endovascular thoracic aortic aneurysm repair
    (Oxford University Press, 2020) Öztaş, Didem Melis; Uğurlucan, Murat; Beyaz, Metin Onur; Ulukan, Mustafa Özer; Ünal, Orçun; Önal, Yılmaz; Umutlu, Muzaffer; Acunaş, Bülent; Alpagut, Ufuk
    OBJECTIVES: Treating aortic arch aneurysms with conventional open surgical and endovascular stent graft procedures is challenging due to the complex anatomy of the arch and the arteries arising from it that nourish the brain. Cerebral protection is of the utmost importance during the treatment of thoracic aneurysms involving the aortic arch.METHODS: Between May 2014 and November 2018, 7 patients with thoracic aortic aneurysms involving the aortic arch who underwent aortic arch cervical debranching with our technique were reviewed retrospectively. Because all the patients being considered for conventional surgical aortic arch replacement had serious comorbidities, they were selected to receive hybrid therapy. The mean age of the patients was 71.2 +/- 9.4 years. One patient was a woman and 6 patients were men. One patient was given general anaesthesia; the remaining 6 patients had a regional block. A crossover temporary bypass was performed between the external carotid arteries with a 6-mm polytetrafluoroethylene graft for cerebral protection in all patients. Thoracic endovascular aortic repair (TEVAR) was successfully performed in all patients except 1 following debranching.RESULTS: Neurological complications did not occur during the procedures. Patients were followed for a mean of 18.3 +/- 4.9 months. One female patient died of exacerbating chronic obstructive pulmonary disease within the first follow-up year. Three other patients died: 1 died of natural causes; 1 died of pneumonia followed by multiorgan failure; and 1 died of myocardial infarction during the mid-term follow-up period. The remaining patients are still being followed and are event free.CONCLUSIONS: Endovascular treatment of thoracic aortic diseases involving the aortic arch is facilitated when the aortic arch is debranched. Our cerebral protection method with a temporary crossover bypass between the external carotid arteries provides continuous pulsatile blood flow to the brain; hence, neurologically, it is a reliable procedure. The follow-up results of the patients who underwent aortic arch cervical debranching followed by TEVAR depended on their comorbidities.
  • Küçük Resim
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    Follow-up results of endovascular aneurysm repair following abdominal visceral debranching
    (Sociedade Brasileira de Cirurgia Cardiovascular, 2022) Öztaş, Didem Melis; Uğurlucan, Murat; Sayın, Ömer Ali; Ekiz, Feza; Önal, Yılmaz; Beyaz, Metin Onur; Umutlu, Muzaffer; Meriç, Mert; Acunaş, Bülent; Alpagut, Ufuk
    Introduction: The aim of this study is to present a series of six cases with thoracoabdominal aneurysm treated with hybrid technique in our center. Methods: Between May 2015 and December 2018, the data of six patients with thoracoabdominal aneurysms and various comorbidities who underwent visceral debranching followed by endovascular aortic aneurysm repair were reviewed retrospectively. Results: Patients’ mean age was 65.3±19.6 years. All of them were male. Comorbidities were old age, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, previous surgical interventions, and/or esophageal hemangioma. Except for one patient who underwent coronary artery bypass grafting (inflow was taken from ascending aorta), debranching was performed from the right iliac artery. Debranching of four visceral arteries (superior mesenteric artery, celiac trunk, and bilateral renal right arteries) was performed in three patients, of three visceral arteries (superior mesenteric artery, celiac trunk, right renal artery) was performed in one, and of two visceral arteries (superior mesenteric artery, celiac trunk) was performed in two patients. Great saphenous vein and 6-mm polytetrafluoroethylene grafts were used in one and five patients, respectively, for debranching. Endovascular aneurysm repair was performed following debranching procedures as soon as the patients were stabilized. In total, three patients died at the early, mid, and long-term follow-up due to multiorgan failure, pneumonia, and unknown reasons. Conclusion: Hybrid repair of thoracoabdominal aneurysms may be an alternative to fenestrated or branched endovascular stent grafts in patients with increased risk factors for open surgical thoracoabdominal aneurysm repair; however, the procedure requires experience and care.